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Forms and Applications

Enrollment Forms and Applications

There are no pdf enrollment forms or applications at this time.

Change of Name Request Form.pdf

The Student Insurance Appeal form will be available until October 31st. Please complete and submit to the school as directed.


All documents are in .PDF format. In order to read and print your enrollment form, you will need to have Adobe Reader downloaded and installed on your computer. You may click on the image below to download Adobe Reader.


  • Gallagher Student Health & Special Risk
    500 Victory Road, Quincy, MA 02171
  • Phone
    617-769-6092
  • Toll Free
    877-373-2405
  • Fax
    617-479-0860
  • Email
    conncoll@gallagherstudent.com